DISEASES OF THE PERICARDIUM. 199 



with adhesions, in complete recovery, or in death (usually 

 by syncope). The prognosis is not unfavourable except in 

 very severe cases. 



Morbid Anatomy. — The anatomical changes in pericar- 

 ditis vary considerably with the severity and nature of the 

 attack. On the whole they resemble those already described 

 in inflammation of the pleura. 



The effusion, which is sero-fibrinous, is usually consider- 

 able, and when small may soon be absorbed. 



Complete restoration is rare, for more or less extensive 

 adhesions and agglutination usually persist. In many cases 

 the plastic material eff"used spreads over the surface of 

 the heart, assuming a reticulated appearance of considerable 

 thickness. 



In some cases the effusion is blood-stained, and in others 

 it may mingle with pus. In the pericarditis of acute 

 rheumatism and epizootic fevers the cardiac muscle and the 

 endocardium are also generally involved. 



Treatment. —In the early stages of primary pericarditis, 

 with a full hard pulse, Fleming's tincture of aconite, with 

 nitric ether and liquor ammonia acetatis is recommended in 

 moderate doses. If the pain continue unallayed, tincture of 

 opium should be substituted for the aconite. Digitalis does 

 not seem to have a beneficial action in pericarditis. In 

 the early stages some recommend moderate bleeding, which 

 they repeat a second time if necessary, or follow up the first 

 abstraction of blood by the administration of Fleming's 

 tincture. Under no circumstances should bleeding be 

 adopted, except to relieve urgent symptoms in the early 

 stages, as in pericarditis there is great tendency to early 

 diminution of the cardiac power. 



Woollen cloths wrung out from hot water should be 

 wrapped round the chest, as in pleurisy, and should not be 

 re-applied for a couple of hours. During the intervals the 



